Reporting Medicaid Fraud & Abuse

Which People Or Companies Do I Report?

Report the Medicaid providers whom you suspect have committed fraud or abuse. A Medicaid provider includes any individual, corporation, or other entity paid by Medicaid for providing a health care service. It also includes their officers and employees.

Medicaid is a state-administered program established by Title Nineteen of the Social Security Act and funded by federal, state, and county funds. It provides medical assistance to qualifying low-income individuals and families. Medicaid is overseen by the United States Department of Health and Human Services and administered in North Carolina by the North Carolina Department of Human Services, Division of Medical Assistance.

Why Report Medicaid Fraud and Abuse?

Patient abuse and the embezzlement, theft, and commingling of Medicaid funds should be reported because it exploits our most vulnerable elderly adults.

Medicaid fraud should be reported because Medicaid payments are made from federal, state, and county funds supplied by taxpayers. When Medicaid funds are lost or stolen through fraud, that money is no longer available to help deserving patients.

Medicaid fraud cheats both recipients and taxpayers, but criminal convictions can deter fraud and abuse. Civil suits can also help recover money that can be returned to the Medicaid program to help patients.

Protection for Whistleblowers

State and Federal laws provide protection to employees who report fraud or abuse. Any employee who is discharged, demoted, suspended, threatened, harassed, or discriminated against by his or her employer for reporting fraud is entitled to relief, including job reinstatement, twice the amount of back pay, and compensation for any court costs and attorneys’ fees.

Federal law provides that whistleblowers who qualify can file a civil false claims act action in federal court under 31 U.S.C. § 3729 and be awarded a percentage of the proceeds of the action or settlement. Whistleblowers should seek the advice of an attorney to determine whether they qualify.

Medicaid recipient fraud, which is fraud committed by those being served by Medicaid, including fraudulent eligibility and transfer of assets, should be reported to the state Division of Medical Assistance at 1-800-662-7030 or to your local county Department of Social Services.